Councils to have legal obligation to run health visitor services
The commissioning of core health visiting services is set to transfer from the NHS to local councils next year, the Department of Health has confirmed.
Under government plans, local authorities will take over responsibility for commissioning public health services for under fives from October 2015, including health visiting and family nurse partnership schemes for teenage mothers.
“Mandating the core elements of this service and transferring commissioning to local authorities is a major step forward”
While councils will be responsible for ensuring the provision of these services, health visitors will still be employed by the NHS.
As part of the switch, the government will initially make it mandatory for councils to ensure the provision of five key elements of the Healthy Child Programme delivered by health visitors – initial antenatal assessments, new baby reviews and child development checks at six to eight weeks, one year and two to two and a half years.
The DH said the mandate would help ensure a strong focus on maternal mental health and early bonding between mothers and babies.
However, it confirmed this legal obligation would initially run for just 18 months. When this period ends in April 2017, councils may be given greater flexibility to decide how the service is provided.
“Health visitors and their teams provide crucial support to children, new parents and families,” said children’s health minister Dan Poulter.
“They can also spot problems or risks to the family, for example if a parent is struggling to cope or the child has a health issues which needs special attention,” he said.
“Mandating the core elements of this service and transferring commissioning to local authorities is a major step forward to provide high quality care for each and every child and new family,” he added.
The DH said the regulations it was drafting would include a “sunset clause” at 18 months.
The arrangement – which still has to be agreed by parliament – will be reviewed by Public Health England after a year to inform “arrangements going forward”, the department said.
The move to local authority commissioning next year follows an increase in health visitor numbers, with a government commitment to ensure 4,500 extra health visitors by 2015.
Supporters say it should enable more streamlined commissioning of public health services for children and teenagers, as councils already commission those for five to 19-year-olds and can also make links with other services such as early education and social care.
To help smooth the transition, the DH said the NHS and local authorities were working together to jointly commission health visiting services this year.
Most public health funding was transferred from the NHS to local authorities and Public Health England in 2013, but the budget for children’s public health commissioning for 0-5 year-olds – which covers health visitors – was transferred to NHS England as an interim measure.
“Local authorities are looking forward to working closely with health visitors to provide the best possible services for families”
LGA and SLACESM
The transfer aimed to address concerns that local authorities would not meet the prime minister’s commitment to boost health visitor numbers by 4,200 before the next general election in May.
But the Community Practitioners’ and Health Visitors’ Association raised concerns that services might also be at risk once the 18-month mandate expired.
While the legal mandate was welcome, the problem of short termism remained, especially as town halls are cash-strapped because of the government’s austerity programme, said CPHVA spokeswoman Rachael Maskell.
“There is no medium-to-long term plan for supporting this service and therefore this is just a ‘quick fix’ and ‘plugging a gap’,” she said.
She added: “There also needs to be continual vigilance to ensure that health visiting is supported by the right number of health visitors – the CPHVA recommends each health visitor has a caseload of 250 families.”
The Royal College of Nursing echoed the CPHVA’s warning about the importance of sustaining funding levels for early years nursing after the mandate period.
“It’s so important that the commissioning of health visitor services is undertaken properly,” said Fiona Smith, RCN adviser for children and young people.
“We welcome the confirmation from the Department of Health that it will mandate universal elements of the Health Child Programme to local authorities,” she said in response to the government’s announcement.
“However, it’s also crucial that these services remain in place beyond the transition period, whatever the organisational structure being used for commissioning in 18 months’ time,” she added.
“It’s also crucial that these services remain in place beyond the transition period”
Meanwhile, the Local Government Association and the Society of Local Authority Chief Executives and Senior Managers, warned that a “great deal of work” remained to be done to ensure every area had sufficient funding to deliver its new responsibilities for health visiting.
In a joint statement, they added: “We are pleased that the government has listened to our concerns about the importance for local authorities of having long-term flexibility to manage these services locally.
“Local authorities are looking forward to working closely with health visitors to provide the best possible services for families, integrating with wider health, social care and education services,” they said.
Prime minister David Cameron recently announced that health visitors would in future be expected to offer relationship advice to new parents, as part of plans to boost overall support for parents.